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Maternity protection is increasingly important for working women worldwide. Most African countries have some maternity protection provisions, but little is known about their utility in practice. This article described how female health workers combined infant feeding and employment. Individual interviews were conducted with 12 female health workers at a hospital in Dar es Salaam, Tanzania. The data was transcribed, translated, and qualitative content analysis applied. Four ways of handling infant feeding and employment emerged: preparing during pregnancy and maternity leave; maximizing breastfeeding during time off work; creating time to breastfeed during the working day; and finding someone else to manage infant feeding during the mother's absence at work. Diverse and flexible workplace and family solutions are needed to cater for employed mothers’ needs. Self-efficacy in handling infant feeding and employment is yet another factor to consider beyond the concepts of time, space/proximity, support and gatekeepers described in the literature.

With a focus on traditional practices rather than evidence-based practices, breastfeeding support is sub-optimal in confinement centres (CCs). We used a participatory, needs-based approach to develop a training module for CC staff adopting Kern’s six-step approach as our conceptual framework. Of 46 identified CCs, 25 accepted our invitation to a dialogue aimed at establishing relationships and understanding their needs. An interactive training workshop was developed from the dialogue’s findings. The workshop, attended by 32 CCs (101 participants), was conducted four times over a four-month period. Questions raised by the participants reflected deficits in understanding breastfeeding concepts and erroneous cultural beliefs. Correct answers rose from 20% pre-test to 51% post-test. Post-workshop feedback showed that participants appreciated the safe environment to ask questions, raise concerns and correct misconceptions. An interview conducted 14 months later showed that while some CCs improved breastfeeding support, others made no change due to conflict between breastfeeding and traditional postnatal practices, which was aggravated by a lack of support due to the COVID-19 pandemic. A participatory approach established a trustful learning environment, helping CCs appreciate the value of learning and adopting new concepts. However, cultural perceptions take time to change, hence continuous training and support are vital for sustained changes.